TOPICS IN GERIATRICS: Integumentary Changes and Associated Issues
The integumentary system is vital in that it protects patients from various sources of damage, from abrasive forces to infectious diseases. Changes in the integumentary system associated with aging require the clinician and patients to pay close attention to the care of skin and its components. Failure to address these issues could have serious health consequences for the aging patient.
LEARNING OBJECTIVES:
1. Gain an understanding of major integumentary changes that occur in geriatric patients.
2. Learn how to screen for integumentary issues.
3. Learn how wound healing differs in geriatric patients.
4. Learn how to address/prevent integumentary damage.
Integumentary Changes in Aging Populations
-The epidermis thins, making it more susceptible to tearing.
-The number of melanocytes decrease, making skin appear more pale and even translucent.
-Superficial blood vessels become more fragile. Bleeding under the skin and bruising more likely.
-Oil production decreased due to less activity from sebaceous glands. Skin is more difficult to keep hydrated and may be itchy.
-Sweat glands are not as efficient and produce less perspiration during exercise.
-Skin loses some elasticity, which can cause it to hang loosely.
-Number of Langerhan's cells and mast cells decrease, increasing risk of skin cancer and infection.
-Number of fibroblasts decreases, adversely affecting ability to heal.
Integumentary Screening and Skin Assessments
Performing a thorough inspection of the skin is critical in the aging patient due to increased risk of integumentary breakdown. Screening should include questions concerning personal and family history of skin issues. The clinician should ask about bathing routines as well as topical products used by the patient. Inspect the skin for dryness, pruritus, rashes, wounds, and abnormal changes in color. Suspicious moles or growths should be documented, in addition to asking patient of awareness of growth and if any obvious changes have occurred in previous 6 months. Inspection of nail beds is also critical, as changes often indicate systemic issues.
Wound Healing
Ability for wound healing deteriorates with age and can often lead to lack of complete healing and development of chronic wounds. Decreased cardiac output and high incidence of arteriosclerosis decreases the cardiovascular perfusion of the skin. The decrease in blood supply means that wounds do not receive the oxygen necessary to heal as efficiently as wound in younger populations. Alterations in immune response, fibroblast function, angiogenesis, and keratinocyte migration all contribute to delayed wound healing. Each stage of the healing process has increased duration in the geriatric population. The inflammatory response may last 5-6 weeks and is characterized by delayed recruitment of macrophages and B-lymphocytes. The proliferative phase shows an age-associated decrease in the re-epithelialization rate while remodeling and maturation can take 2-5 years. Tensile strength of the scar tissue is reduced making dehiscence more likely. Factors that may affect duration of wound healing are listed below:
Intrinsic Factors: Health Status, Body Build, Immune Function, Nutritional Status, Diabetes, Age Factors
Extrinsic Factors: Mechanical Stress, Infection, Debris, Chemical Stress, Temperature, Dessication, Maceration
Addressing Integumentary Damage
Malnutrition in the aging population is common and detrimental to the care of integumentary damage. As a PT, we need to be aware of nutritional issues and consider referral for possible nutritional supplementation in aging patients. Studies have shown that energy-dense and protein-rich foods improve both wound healing and cognitive function in these populations. Prevention of integumentary damage is crucial and awareness of causative factors can help the PT avoid integumentary insult. Common causes of damage include shear forces on fragile skin and pressure ulcers from decreased mobility and prolonged static posturing.
References Collins CE, Kershaw J, Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: A randomized trial. Nutrition. 2005;21(2):147-55.
Thomason HA, Hardman MJ. Delayed wound healing in elderly people. Reviews in Clinical Gerontology. 2009;19(3):171-184.
Brown, Katherine L. and Tania J. Phillips. "Nutrition And Wound Healing". Clinics in Dermatology 28.4 (2010): 432-439. Web. 7 July 2016.
Benbow M. Ageing & wound healing. Journal Of Community Nursing [serial online]. September 2010;24(5):36-40 3p. Available from: CINAHL Complete, Ipswich, MA. Accessed July 5, 2016.
Updated by: Robert Hurd, and the A.D.A.M. Editorial team. "Aging Changes In Skin: Medlineplus Medical Encyclopedia". Nlm.nih.gov. N.p., 2016. Web. 7 July 2016.
The integumentary system is vital in that it protects patients from various sources of damage, from abrasive forces to infectious diseases. Changes in the integumentary system associated with aging require the clinician and patients to pay close attention to the care of skin and its components. Failure to address these issues could have serious health consequences for the aging patient.
LEARNING OBJECTIVES:
1. Gain an understanding of major integumentary changes that occur in geriatric patients.
2. Learn how to screen for integumentary issues.
3. Learn how wound healing differs in geriatric patients.
4. Learn how to address/prevent integumentary damage.
Integumentary Changes in Aging Populations
-The epidermis thins, making it more susceptible to tearing.
-The number of melanocytes decrease, making skin appear more pale and even translucent.
-Superficial blood vessels become more fragile. Bleeding under the skin and bruising more likely.
-Oil production decreased due to less activity from sebaceous glands. Skin is more difficult to keep hydrated and may be itchy.
-Sweat glands are not as efficient and produce less perspiration during exercise.
-Skin loses some elasticity, which can cause it to hang loosely.
-Number of Langerhan's cells and mast cells decrease, increasing risk of skin cancer and infection.
-Number of fibroblasts decreases, adversely affecting ability to heal.
Integumentary Screening and Skin Assessments
Performing a thorough inspection of the skin is critical in the aging patient due to increased risk of integumentary breakdown. Screening should include questions concerning personal and family history of skin issues. The clinician should ask about bathing routines as well as topical products used by the patient. Inspect the skin for dryness, pruritus, rashes, wounds, and abnormal changes in color. Suspicious moles or growths should be documented, in addition to asking patient of awareness of growth and if any obvious changes have occurred in previous 6 months. Inspection of nail beds is also critical, as changes often indicate systemic issues.
Wound Healing
Ability for wound healing deteriorates with age and can often lead to lack of complete healing and development of chronic wounds. Decreased cardiac output and high incidence of arteriosclerosis decreases the cardiovascular perfusion of the skin. The decrease in blood supply means that wounds do not receive the oxygen necessary to heal as efficiently as wound in younger populations. Alterations in immune response, fibroblast function, angiogenesis, and keratinocyte migration all contribute to delayed wound healing. Each stage of the healing process has increased duration in the geriatric population. The inflammatory response may last 5-6 weeks and is characterized by delayed recruitment of macrophages and B-lymphocytes. The proliferative phase shows an age-associated decrease in the re-epithelialization rate while remodeling and maturation can take 2-5 years. Tensile strength of the scar tissue is reduced making dehiscence more likely. Factors that may affect duration of wound healing are listed below:
Intrinsic Factors: Health Status, Body Build, Immune Function, Nutritional Status, Diabetes, Age Factors
Extrinsic Factors: Mechanical Stress, Infection, Debris, Chemical Stress, Temperature, Dessication, Maceration
Addressing Integumentary Damage
Malnutrition in the aging population is common and detrimental to the care of integumentary damage. As a PT, we need to be aware of nutritional issues and consider referral for possible nutritional supplementation in aging patients. Studies have shown that energy-dense and protein-rich foods improve both wound healing and cognitive function in these populations. Prevention of integumentary damage is crucial and awareness of causative factors can help the PT avoid integumentary insult. Common causes of damage include shear forces on fragile skin and pressure ulcers from decreased mobility and prolonged static posturing.
Additional Resources
http://libguides.mskcc.org/c.php?g=245208&p=1632425
https://www.atrainceu.com/course-module/2438910-141_elders-and-their-care-module-03
http://www.dermnetnz.org/site-age-specific/ageing.html
https://www.dermalogica.com/why-skin-ages,-and-what-you-can-do-about-it/why-skin-ages-and-what-you-can-do-about-it,default,pg.html
http://www.managedhealthcareconnect.com/article/8869
References
Collins CE, Kershaw J, Brockington S. Effect of nutritional supplements on wound healing in home-nursed elderly: A randomized trial. Nutrition. 2005;21(2):147-55.
Thomason HA, Hardman MJ. Delayed wound healing in elderly people. Reviews in Clinical Gerontology. 2009;19(3):171-184.
Brown, Katherine L. and Tania J. Phillips. "Nutrition And Wound Healing". Clinics in Dermatology 28.4 (2010): 432-439. Web. 7 July 2016.
Benbow M. Ageing & wound healing. Journal Of Community Nursing [serial online]. September 2010;24(5):36-40 3p. Available from: CINAHL Complete, Ipswich, MA. Accessed July 5, 2016.
Updated by: Robert Hurd, and the A.D.A.M. Editorial team. "Aging Changes In Skin: Medlineplus Medical Encyclopedia". Nlm.nih.gov. N.p., 2016. Web. 7 July 2016.